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Routine monitoring discussions should occur if: You have been taking metformin for more than three years without recent B12 testing You are taking high-dose metformin (2g or more daily) You are aged 65 or older You follow a vegan or vegetarian diet You are taking acid-suppressing medications (such as omeprazole or ranitidine) You have other risk factors for B12 deficiency Patients should not commence B12 supplementation without medical advice, as inappropriate supplementation may mask underlying conditions such as pernicious anaemia or other causes of deficiency that require specific investigation and management

108 Ginkgo extract has been shown in preclinical studies to inhibit platelet activating factor (involved in platelet activation) and increase endothelial cell expression of thrombomodulin (activates thrombin) and production of tissue plasminogen activator (stimulates fibrinolysis)

The association of folate and depression: A meta-analysis

Case example : A patient receives e/M visits, including management of migraines, seizures, neuropathies and stroke